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194 Cardio Diabetes Medicine 2017

Low Body Weight T2DM and

Macro Vascular Disease

Prof. Dr. Sidhartha Das,
MD, FRCP(Glasg), FRCP(Edin), FRCP(London)
Senior Consultant in Medicine & Diabetes, Dean and Principal
S. C. B. Medical College and Hospital, Cuttack, Odisha-753007

Abstract : Studies from the United Kingdom Prospective Dia-
Low Body Weight Type 2 DM is a distinct clinical en- betes Study (UKPDS) had revealed that patients with
tity which is neither related clinically nor pathophys- Type2DM have a two to three fold increase in dis-
iologically to LADA nor former fruste of Type 1DM eases related to atheroma. Besides, those diabetic
. They have absence of markers for autoimmune subjects who develop atheroma related disease in
destruction of ∼-cells along with good insulin and the age range of 40 to 50 years of age have a two-
C-peptide reserve for a prolonged period of life. The fold higher rate of mortality.
clinical presentation and profile of associated com- Type 2 Diabetes Mellitus: (DM) is the most prevalent
plications in Low Body weight Type 2 DM are visi- form of DM seen in India and constitutes more than
bly different from those described for subjects with 95% of the diabetic population.
classical Type 2 DM. The Low Body weight Type 2
DM patients have a marked lower incidence of hy- Epidemiological data has revealed that the clinical
pertension, CAD, nephropathy vis-a-vis marginally and phenotypic profile of patients with Type 2 DM
higher prevalence of retinopathy and a markedly are different in India and certain developing coun-
higher incidence of peripheral neuropathy and in- tries of Asia and Africa when compared to the West.
fections. A lipid profile which is non-conducive for (R2). The profile , presentation and complications in
atherogenesis, lower levels of non-lipid risk factors subjects with Non-Insulin Dependent Diabetes Mel-
like homocysteine and lower levels of inflammatory litus (NIDDM) seen in India was much different from
markers like hsCRP with lesser expression of NF-κB those NIDDM of the West. This was recorded, for
in mononuclear cells are probable explanations to the first time, as a consensus statement adopted
the lesser prevalence of macrovascular disese (MVD) at the “ International Workshop on Types of Dia-
in Low Body Weight Type2 DM. betes Peculiar to the Tropics”, held at Cuttack, India.
The consensus statement published in Diabetes
Care (1996) read as, “This group supports the WHO
Introduction:
classification of NIDDM into Obese & Non-obese sub-
The post insulin era experienced the visible decline classes. In some developing countries, non-obese
in prevalence of acute complications and infections patients constitute the more common category,
in patients with diabetes mellitus (DM). However, and a proportion of them have BMI<18.5. There are
macrovascular disease (MVD) emerged as the most many factors that are not well understood in these
threatening complication in diabetics of the west. Al- subjects with NIDDM and Low body weight ; further
most 2/3 of deaths in diabetics was attributed to research is required in this group.(R3)
rd
coronary artery disease (CAD), cerebrovascular dis-
ease (CVD) or peripheral vascular disease (PVD). The Burden of MVD in Diabetics with special
problem although more marked with Type-2 diabet- reference to Indians:
ics (earlier nomenclature as NIDDM) is also a major
cause of morbidity and mortality in Type-1 diabetics. Atherosclerosis (AS) is more prevalent in subjects
Therefore, the American Heart Association (AHA) with DM. Involvement of vascular channels is more
has designated DM as a major risk factor for car- wide spread in diabetic subjects as compared to non
diovascular disease. diabetics. The duration of chronic hyperglycemias is

GCDC 2017